Embolization in the Treatment of a Major Retropubic Hemorrhage Following Tension-Free Vaginal Tape: A Case Report and Literature Review

Abstract

55-year-old para 2 woman was brought to the emergency department following insertion of a tension-free vaginal tape complaining of lower abdominal pain and vertigo. The subsequent angiography localized a significant bleeding from the right obturator artery and a retropubic hematoma 17.5 cm × 10.0 cm in size. The patient was successfully treated by arterial embolization; however, the postoperative course was greatly protracted due to persistent subfebrilia and eventually the hematoma was removed by laparoscopy. This case illustrates that embolization should be considered an important alternative for management of arterial bleeding following synthetic midurethral slings. However, removal by laparoscopy or laparotomy may be necessary in large hematomas subsequently to embolization.